Member Enrollment Process Automation for a Fortune 500 Health Plan

Overview

The Health Plan holds its expertise in three major areas of Government sponsored health care: Medicaid, Medicare Advantage and Medicare Prescription Drug Plans and serves nearly 6 million members across the United States.

Bottlenecks in Delivering a Great Member Experience

The Health Plan aimed to improve the quality of care and services to help its members access the right care at the right time. However, its operational shortfalls were holding it back from delivering on its business strategy.

The Health Plan’s enrollment agents used to meet beneficiaries to fill paper-based enrollment forms, such as medical, pharmacy and others. Else, the agents used a portal to fill member enrollment forms over the web. The web-based portal had certain limitations. The portal didn’t allow enrollment agents to make even minor modifications or configure new rules and products. All these were adversely affecting the company’s operational costs and efficiencies, while leading to lengthy turnaround times, manual errors, low workforce productivity, and several compliance risks.

Business Benefits Achieved

With easily accessible member information, agents can operate 24*7 while reducing the costs incurred in maintaining 3rd party systems and teams for handling paper-based applications. Some of the other benefits include:

• Faster time to market
• First-time-right
• Better performance & security
• Higher compliance
• Increased sales opportunity
• Higher workforce optimization